Mothers who receive prenatal oral health care can help protect their children from the onset of early childhood caries (ECC) and Streptococcus mutans before they reach 5 years of age, according to a systematic review and meta-analysis published in the June issue of Caries Research.
Authors designed the study to review the association between prenatal oral health care and the reduction of S. mutans and prevention of ECC. Authors retrieved case-control studies, retrospective or prospective cohort studies, and randomized or nonrandomized controlled trials from a May 2018 search of databases including PubMed, Embase, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Cochrane Library, and Clinicaltrials.gov. Authors used the Cochrane Collaboration tool to measure risk of bias in randomized trials, and the adapted Downs and Black scoring to measure the quality of randomized and nonrandomized studies.
After an initial search that yielded 4,956 articles, authors chose 5 for review. Of these, 3 were randomized control trials, 1 was a prospective cohort study, and 1 was a nested case-control study. Authors used a linear mixed-effects model for meta-analysis of 4 studies of ECC incidence reduction. One study was excluded from meta-analysis because it included oral S. mutans carriage in children but not ECC as the outcome. The studies featured oral health intervention strategies that included fluoride supplements, oral health education, oral examinations and prophylaxis, dental treatment referrals, and xylitol gum chewing.
The authors found that the odds ratio (OR) of ECC in children whose mothers received oral health care education was 0.17 (95% confidence interval [CI], 0.06 to 0.49) compared with the control group; 0.36 (0.15 to 0.85) for children whose mothers received prenatal health care, and 0.94 (0.57 to 1.56) for children whose mothers received a fluoride supplement.
Authors also found that the odds of children younger than 4 years experiencing ECC was significantly less than the control group. The estimated ORs (95% CI) were 0.12 (0.02 to 0.77) for 1-year-old children, 0.18 (0.05 to 0.63) for 2-year-old children, 0.25 (0.09 to 0.64) for 3-year-old children, and 0.35 (0.12 to 1.00) for 4-year-old children. The studies showed a statistically significant difference in ECC among the intervention and control groups for children younger than 4 years, regardless of intervention type.
Two studies measured the effect of prenatal oral health care intervention on reducing S. mutans in children. One study found that 100% of children in the intervention group remained free of S. mutans by age 3 years compared with 38.5% of children in the control group. Mothers in the intervention group also showed a significant improvement in plaque index and S. mutans reduction scores. A second study showed that significantly more children in the xylitol gum chewing group remained S. mutans free at 9, 12, and 24 months. Prenatal xylitol gum chewing by mothers also delayed the carriage of S. mutans in children at 8.8 months compared with the control group.
Read the study here or contact the ADA Library & Archives for assistance.
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Poor oral health still linked to academic outcomes
The relationship between a child’s poor oral health and academic outcomes is consistent across age, sex, family income, and type of health insurance, according to a study published in the June 2019 issue of The Journal of Pediatrics.
Authors based their findings on data from the 2016-2017 National Survey of Children’s Health, which featured questions about academic performance, oral health problems, and parent-related oral health. They analyzed data from 45,711 children aged 6 through 17 years.
Academic performance outcomes for the survey included problems at school and the number of school days missed due to health issues. The survey’s oral health measurements included the child’s current oral health status rating (excellent, very good, good, fair, or poor), and the presence of specific oral health problems during the past year (toothache, carious teeth, cavities, or bleeding gingivae).
Authors used regression analysis models for academic performance indicators on oral health measures to adjust for demographics, socioeconomic status, medical history, and state-fixed effects. They applied logistic regression and survey sampling weights to obtain nationally representative estimates. All models included the total sample and school-age group: elementary school (6-11 years), middle school (12-14 years), and high school (15-17 years). Authors also stratified data by age, sex, household income, and type of insurance in their analyses.
In all, authors found that nearly one-quarter of all children experienced problems at school, and that roughly 23% and 10% missed more than 3 and 6 days of school, respectively. More than 15% experienced at least 1 dental problem, and nearly 6% had their dental health rated as fair or poor. Children with at least 1 dental problem were more likely to experience problems at school (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.32 to 1.85) and miss at least 1 day of school (OR, 1.54; 95% CI, 1.28 to 1.35) by nearly one-half. Children were also more likely to miss more than 3 days of school or more than 6 days of school by 40% (OR, 1.39; 95% CI, 1.2 to 1.61 and OR, 1.39; 95% CI, 1.14 to 1.69, respectively).
Children with poor or fair oral health were nearly 80% more likely to experience problems at school (OR, 1.77; 95% CI, 1.33 to 2.36) and more likely to miss more than 3 days of school or more than 6 days of school by about 60% (OR, 1.56; 95% CI, 1.23 to 1.99) and 90% (OR, 1.93; 95% CI, 1.42 to 2.62), respectively.
Children aged 12 through 14 years with dental problems or fair or poor dental health were twice as likely to have problems at school and to miss more than 3 days of school. Authors noted that poor oral health was consistently related to worse academic performance across age, sex, household income, and health insurance type.
“The consistency of the associations between oral health and academic outcomes across demographic and socioeconomic subgroups suggests that this issue cuts across the population of children,” the authors noted, “further emphasizing the need for population-wide and public health interventions in addition to efforts that target children from lower poorer households such as ensuring adequate access to dental care for children in Medicaid.”
Read the article here or contact the ADA Library & Archives for assistance.
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Pulpectomies offer powerful protection of primary molars
Molars treated with pulpectomies survive much longer than teeth treated with either ferric sulfate (FS) or sodium hypochlorite (SH) pulpotomies. Better survival occurs regardless of type of tooth, provider, visit, or arch. The findings are from a study published in the May/June issue of Pediatric Dentistry.
Authors designed a retrospective cohort study to compare the survival rate of molars across Vitapex pulpotomies, SH pulpotomies, and FS pulpotomies. They compiled data from dental records of Alaska Native children aged 2 through 13 years who received a primary molar pulpectomy or pulpotomy.
Authors grouped patients into pulpectomy, SH pulpotomy, and FS pulpotomy. They used the following criteria to define a successful pulpectomy for a treated tooth: asymptomatic and free of infection, shrunken or resolved radiolucency, presence of a postoperative fistula that showed resolution, and no pathologic external or internal resorption. Authors defined a successful pulpotomy for a treated tooth as asymptomatic and free of infection and no evidence of internal or external resorption or bone destruction.
Authors defined radiographic failure for a treated tooth if it developed a radiographic radiolucency not seen on preoperative radiographs, if the radiolucency remained unchanged or grew from the initial radiograph, or if it showed internal or external resorption that led to bone destruction. Authors defined clinical failure for a treated tooth if it showed signs of infection that needed more root treatment or was extracted or if it showed pathologic mobility. Authors used analysis of variance for continuous variables and Pearson c2 or Fisher exact tests to measure associations between person- and tooth-level characteristics with treatment in contingency tables.
Analyzed data included 1,149 teeth in 830 children. A total of 490 teeth were treated with pulpectomies, 548 teeth with FS pulpotomies, and 111 teeth with SH pulpotomies. Most treated teeth (56%) were first molars, 61% of all treated teeth were mandibular, and nearly 79% of treatments took place in the operating room. Pulpotomies were significantly more likely to be completed in the operating room. (P < .0001). Authors documented 175 radiographic and 59 clinical failures during the course of follow-up.
The authors found that SH pulpotomy was 2.5 times more likely to fail than pulpectomy and that FS pulpotomy was 3.7 times more likely to fail than pulpectomy. Teeth treated with SH and FS pulpotomies showed significantly higher risks of failure compared with those treated with pulpectomies (adjusted hazard ratio [aHR], 2.57 [95% confidence interval {CI}, 1.17 to 5.64]; and aHR, 3.73 [95% CI, 2.25 to 6.16], respectively).
Molar position and dental arch remained significant predictors of failure. Still, authors found that first molars treated with pulpotomies were roughly 3.5 times more likely to fail than those treated with pulpectomies (aHR, 3.46 [95% CI = 1.99 to 6.03]).
“The findings from this study demonstrate that the tooth survival benefit from a pulpectomy did not vary by sex, age, provider type, visit type, or whether the treatment was complete on a first or second molar or in the maxillary or mandibular arch,” the authors concluded. “This is helpful to the provider or institution unfamiliar with a pulpectomy technique, as it supports the idea that, although there are additional steps and training required to treat a molar with a pulpectomy, even the less-practiced clinician should be able to expect a high level of success.”
Read the article here or contact the ADA Library & Archives for assistance.
Effect of low-calorie soda on primary teeth
Dentists should discourage consumption of any low-calorie sodas as they were found to affect the morphology of tooth enamel. The findings are from an in vitro study published in the May/June issue of Journal of Clinical Pediatric Dentistry.
Authors wanted to measure the effect of low-calorie soda consumption on the enamel roughness of primary teeth. They prepared 50 enamel slabs to examine 20 extracted primary teeth from Children’s Hospital of Wisconsin Pediatric Dental Clinic under a 3-dimensional laser microscope. Authors disinfected extracted teeth and stored them in a container with 0.9% sodium chloride for up through 30 days. Roots were placed in an acrylic resin matrix and cured for 2 minutes.
Authors divided the slabs into 5 groups: control (0.9% sodium chloride), sucrose (Coca-Cola Classic), aspartame (Diet Coke), erythritol (Zevia Cola), and stevia (Coca-Cola Life). Enamel slabs in each group were exposed to 2,000 microliters of soda for 60 minutes to simulate the exposure time of a child consuming soda over a 2-week period. Authors examined slabs using a 3-dimensional laser measuring microscope to measure postintervention surface roughness, then used photomicrographs to compare pre- and postintervention slabs. Authors used the Levene statistical test to measure homogeneity of data and a nonparametric Friedman statistical test to compare pre-and postintervention differences among groups.
In all, the authors found that all sodas showed a statistically significant effect on the surface roughness of tooth enamel (P = .000). Surface roughness changed the most between the stevia and aspartame groups. Surface roughness changed the least between the sucrose and erythritol groups. The control group had the highest pH measurement. The sucrose, erythritol, and stevia groups had the lowest or most acidic pH measurements.
“In the future, implementation of a longer exposure time in addition to incubation of the enamel slabs at 370 C may help increase the validity of the results,” the authors noted. “Furthermore, an in vitro design using saliva would increase the clinical applicability of the results.”
Read the study here or contact the ADA Library & Archives for assistance.
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Pediatric courses at ADA FDI World Dental Congress
Courses to consider, among others:
Register today at ADA.org/meeting.
Attend the 2019 ADA Children’s Airway Conference right from your desk
These courses guide the general, pediatric, and orthodontic practitioner in treating and answering questions about SRBD. Visit ADACEOnline.org to find out more information about these and other pediatric dentistry courses.
AAPD plans Safety Symposium for November 8-9 in Chicago
This inaugural course provides a look at safety in pediatric dental care and provides practical tools and the latest clinical advice on how to improve office safety for patients, team members and dentists. This fast-paced session, featuring recognized experts from major areas of dental and medical practice, will help attendees develop a culture of safety, mitigate potential harm related to providing dental care, and take proactive steps for the well-being of both providers and patients.
Topics include:
The consulting editor for JADA+ Specialty Scan — Pediatric Dentistry is James R. Boynton, DDS, MS, Clinical Associate Professor, Pediatric Dentistry Division Head, University of Michigan School of Dentistry. |
The consulting editor for JADA+ Specialty Scan — Pediatric Dentistry is Douglas B. Keck, DMD, MSHEd, Associate Program Director, Advanced Education in Pediatric Dentistry, Providence, Rhode Island NYU Langone Dental Medicine. |
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